Robert Ramón, who assists job seekers at Peckham, Inc., said it's hard for him to smile because of bad teeth. He didn't have insurance and couldn't afford to see a dentist for more than a decade.(Photo: Courtesy)

And on the rare occasion he laughs, his hand automatically flies in front of his mouth.

His smile has been marred by decaying teeth since his days at Bellevue High School in Eaton County.

“It affected me every single day of my life. Every single morning it was the first thing I thought of was ‘Who’s going to see my smile today? Who’s going to see my teeth and say something under their breath?’”

Now, at 30, he’s missing four front teeth as he undergoes costly and lengthy restorative dental work -- after years of neglect.

But his misery has been more than emotional.

He estimates 10 to 15 trips to urgent care and emergency rooms in the decade after high school with tooth and headache pain from abscesses.

Legislation passed in the Senate on Wednesday has the potential to help. A bill to create a new type of health care worker in Michigan, a dental therapist, was approved 21-15 and now goes to the House.

Therapists would do some of the simpler procedures dentists do now, such as filling cavities. They would play a similar role to a dentist that a physician’s assistant or nurse practitioner does to a doctor.

Amy Zaagman, executive director of the Michigan Council for Maternal and Child Health, said dental therapists would treat those who aren’t getting help now.

The legislation would limit them to work for dentists in private practices where a majority of patients are uninsured or on Medicaid, or in rural or other underserved areas in public clinics. There's a big problem now in that most dentists won’t take patients with Medicaid.

“We think this is a safe and effective model of care and there’s no reason to stand in the way of anything that might help,” she said. “It’s not a mandate, just offering people an option.”

Perhaps not surprisingly, the Michigan Dental Association opposes the legislation, saying it’s the wrong fix. The right fix is better payment for taking care of patients on Medicaid, the association argues.

Bill Sullivan, vice president for government affairs for MDA, said patients with Ramón’s complicated problems couldn’t be helped by a dental therapist anyway because they need the higher skills of a dentist.

“They claim it’s going to bring care to the underserved Medicaid population. That’s the population that has the most complex problems,” he said.

It’s a chicken-or-egg argument. Could Ramón’s problems have been tackled much earlier by dental therapists who would have accepted lower pay than full-fledged dentists? Impossible to say, but dental therapists have worked in a handful of other states.

Sen. Curtis Hertel Jr., D-East Lansing, a co-sponsor of the bipartisan bill, is pushing back against the dentists' arguments.

“The Dental Association was trying to argue that a dental therapist is less qualified care. My response back was less qualified than what? Nothing?” he said.

He agrees that Medicaid reimbursement rates are too low but that’s unlikely to change anytime soon.

“Right now there is a group of people in our state that needs access and are not being served.”

Ramón grew up in a struggling household and saw a dentist a few times as a child, with coverage through a state and federal insurance program. After 18, though, he had no insurance and he couldn’t afford to pay out of pocket. His teeth got worse.

A few years ago that changed when he was hired by Capital Area Michigan Works to assist job seekers and the unemployed. He now holds a similar job with Peckham, Inc. working out of the same office. It offers insurance and decent pay.

A dentist pulled 14 abscessed and decayed teeth last year as he inches toward implants. He spent $3,000 out of pocket on top of insurance and a GoFundMe account.

He hopes to have a beautiful smile in the near future.

It’s hard for those with good teeth to understand what he's been through, Ramón said. And he's embarrassed.

“It haunted me,” he said.

Judy Putnam is a columnist with the Lansing State Journal. Contact her at (517) 267-1304 or at jputnam@lsj.com. Follow her on twitter @judyputnam.